Pharmacology Flashcards
(27 cards)
List the steps for pain killer treatment
1- non-opioid (NSAID, paracetamol)
2- weak opioid (codeine) +/- non-opioid +/- adjuvant
3- strong opioid (morphine)
Name some examples of NSAIDs
Ibuprofen
Aspirin
Naproxen
What are the indications for NSAIDs
Inflammatory arthritis
Mechanical musculoskeletal pain
Pleuritic chest pain
And many more
What are the effects of NSAIDs
Anti-inflammatory
Analgesic
What are the side effects of NSAIDs
Peptic ulceration Renal impairment Increased CV risk Exacerbation of asthma Fluid retention
What is the first choice of DMARD in most conditions
Methotrexate
As DMARDs are slow acting, which drugs are used alongside them
NSAIDs and short-term steroids
Cover the period where DMARD is not yet fully active
How is methotrexate given
orally or subcutaneously
What conditions is methotrexate used in
RA
psoriatic arthritis
connective tissue diseases
What are the side effects of methotrexate
Leucopoenia (suppresses white cells and patients)
Hepatitis/cirrhosis
Nausea
Pneumonitis
What monitoring is necessary for methotrexate patients
Must get regular blood tests to monitor LFT and WBC
white cell count often drops with treatment
How is sulfasalazine used
In combination with methotrexate
Is sulfasalazine safe in pregnancy
Yes
What are some side effects of sulfasalazine
Nausea Rash Mouth ulcers Neutropenia Hepatitis Reversible low sperm count
What is hydroxychloroquine used for
Connective tissue disease
Lupus
Mild DMARD - no effect on joint damage
What are the side effects of hydroxychloroquine
Usually well tolerated
Rarely causes eye problems
What are biologics
Drugs designed to target specific aspects of the immune system that may be implicated in inflammatory arthritis
Targets include: TNF, B cells, Interleukin 6, 17, 12 and 23
Biologics are more effective than DMARDs - true or false
TRUE
Get a response from 2/3 of patients but difference is amazing
What diseases is anti-TNF licenced for use in
RA
psoriatic arthritis
ankylosing spondylitis
What are some side effects of anti-TNF therapy
Increased skin cancer risk
Increased risk of infection
Can reactivate latent TB
Exacerbate HF
Is anti-TNF treatment safe in pregnancy
Yes
May need to be stopped in 3rd trimester
What are the side effects of colchicine
Diarrhoea
Vomiting
How do you build up treatment in acute gout
Tend to try anti-inflammatory first, then colchicine, then steroids (oral or IM)
What are some side effects of allopurinol
Rash - most common
Reacts with azathioprine and can rarely lead to marrow suppression
